Abstract

OBJECTIVE: Serum IGF-I levels are monitored during
GH replacement treatment in adults with GH defi-
ciency (GHD) to guide GH dose adjustment and to
minimize occurrence of GH-related side-effects. This
is not routine practice in children treated with GH. The
aim of this study was to evaluate changes in (1) serum
IGF-I, IGFBP-3 and IGF-I/IGFBP-3 molar ratio, and (2)
serum leptin, an indirect marker of GH response,
during the first year of GH treatment in children with
disordered growth.

DESIGN: An observational prospective longitudinal
study with serial measurements at five time points
during the first year of GH treatment was carried out.
Each patient served as his/her own control.
PATIENTS The study included 31 patients, grouped
as (1) GHD (n=20) and (2) non-GHD (Turner syndrome
n=7; Noonan syndrome n=4), who had not previously
received GH treatment.

MEASUREMENTS: Serum IGF-I, IGFBP-3 and leptin
levels were measured before treatment and after
6 weeks, 3 months, 6 months and 12 months of GH
treatment, with a mean dose of 0.5 IU/kg/wk in GHD
and 0.7 IU/kg/wk in non-GHD groups. IGF-I, IGFBP-3
and the calculated IGF-I/IGFBP-3 molar ratio were
expressed as SD scores using reference values from
the local population.

CONCLUSIONS: The pattern of IGF-I, IGFBP-3 and
their molar ratio during the first year of GH treatment
differed between the GHD and non-GHD groups. Calculation
of GH dose by surface area may be preferable
to calculating by body weight. As a GH dose-dependent
increase in serum IGF-I and IGF-I/IGFBP-3 may
be associated with adverse effects, serum IGF-I and
IGFBP-3 should be monitored routinely during longterm
GH treatment. Serum leptin was the only variable
that correlated with first year growth response in
GHD.